Provider Demographics
NPI:1275578155
Name:COLLINS-REED, ELLEN CATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CATHERINE
Last Name:COLLINS-REED
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2670
Mailing Address - Country:US
Mailing Address - Phone:802-440-8005
Mailing Address - Fax:802-440-8110
Practice Address - Street 1:901E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2670
Practice Address - Country:US
Practice Address - Phone:802-440-8005
Practice Address - Fax:802-440-8110
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0000776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010817Medicaid
VT27-0105777Medicare UPIN